With the increasing resolution of modern CT scanners, analysis of the larger numbers of images acquired in a lung screening exam or diagnostic study is necessary, which also needs high accuracy and reproducibility. Recent developments in the computerized analysis of medical images are expected to aid radiologists and other healthcare professional in various diagnostic tasks of medical image interpretation. This article is to provide a brief overview of some of computer-aided diagnosis schemes in chest CT. (Tuberc Respir Dis 2004; 57:515-521)
배 경 : 객담 항산균 도말 검사는 저렴하고 간편한 검사이며, 검사 결과를 빨리 얻을 수 있다는 장점이 있지만, 결핵균과 NTM을 구별하지 못한다는 제한점이 있다. 외국에서는 도말 양성 환자에서 폐결핵과 NTM 폐질환을 구별하기 위하여 TB-PCR 검사가 권장되고 있다. 본 연구는 국내에서도 객담 도말 양성 환자에서 객담 또는 기관지 세척액의 TB-PCR 검사가 폐결핵과 NTM 감염의 감별 진단에 유용한가를 알아보고자 하였다.대상 및 방법 : 2003년 1월 1일부터 2003년 12월 31일까지 1년간 진단검사의학과 임상미생물검사실로 항산균 도말 및 배양검사가 의뢰된 객담 검체 중 도말과 배양이 모두 양성인 826건의 객담 검체를 연구대상으로 하였고, 이 검체가 분리된 환자 299명의 의무기록과 방사선학적 소견을 후향적으로 조사하였다.
Background : Microscopic examination of sputum smears for acid-fast bacilli (AFB) is the most important and rapid diagnostic test for pulmonary tuberculosis. However, the AFB observed on the smear may represent either M. tuberculosis or nontuberculous mycobacteria (NTM). This study examined the clinical usefulness of a polymerase chain reaction test for M. tuberculosis (TB-PCR) for the differentiation of pulmonary tuberculosis and NTM lung disease in patients with smear-positive sputums in a tertiary hospital in Korea. Material and Methods : From January, 2003 to December, 2003, 826 AFB smear-positive and culture-positive sputum specimens were collected from 299 patients. Results : NTM were recovered from 26.6% (220/826) of the smear-positive sputum specimens and 23.4% (70/299) of the patients with smear-positive sputum. All the patients with isolated NTM had clinically significant NTM lung disease; 38 patients (54.3%) had M. avium and 26 patients (37.1%). had M. abscessus. In the patients with pulmonary tuberculosis, 78.7% of the patients (74/94) showed TB-PCR positivity, and all the patients with NTM lung disease showed negative results on the TB-PCR test (p<0.001). A positive result of the TB-PCR test on the sputum or bronchial washing fluid specimens was able to predict pulmonary tuberculosis with 88.4% sensitivity, 100% specificity, a 100% positive predictive value and a 79.7% negative predictive value for the patients with smear-positive sputum. Conclusion : The TB-PCR test for sputum specimens or bronchial washing fluid specimens could be useful for differentiating pulmonary tuberculosis and NTM lung disease for the patients with smear-positive sputum in Korea. (Tuberc Respir Dis 2004; 57:528-534)
Background : Airway remodeling of the asthmatic airway, the result of persistent inflammation in the bronchial wall, is associated with irreversible airway obstruction and the severity of asthma. Previous reports had represented that adminitering CpG-oligodeoxynucleotides (CpG-ODN) before sensitization or challenge by allergens inhibits the development of eosinophilic airway inflammation in a murine model of asthma, but the effects of CpG-ODNs on chronic inflammation and airway remodeling had not been characterized. To investigate the influence of CpG-ODNs on chronic inflammation and remodeling of the airway, we performed studies using a murine model of chronic allergen-induced asthma. Methods : Balb/C mice were sensitized to ovalbumin(OVA) and subsequently exposed to nebulized OVA by means of inhalation twice weekly for 7 weeks. CpG-ODNs(30 μg) was administered intraperitoneally at sensitization. After final inhalation, mice were evaluated for airway hyperresponsiveness, chronic airway inflammation and remodeling. Results : The mice exposed to chronic and recurrent airway challenge with OVA had persistent airway hyperresponsiveness, chronic inflammation and airway remodeling. Mice treated with CpG-ODNs exhibited decreased bronchial hyperresponsiveness, OVA-specific IgE, chronic inflammation and evidence of airway remodeling, including goblet cell hyperplasia and subepithelial fibrosis. Conclusion : CpG-ODNs was thought to prevent chronic inflammation and remodeling changes in a murine model of chronic asthma. (Tuberc Respir Dis 2004; 57:543-552)
Bacillus species are aerobic, gram-positive, spore forming rods, and they are usually found in the surrounding environment. If they are isolated in the clinical specimen, they are generally considered as contaminants rather than a true pathogen. Infection with Bacillus licheniformis is usually associated with the immunocompromised state, trauma, an indwelling intravenous catheter or an intravenous drug abuser. This infection is easily controlled by removal of the catheter and surgical debridement of the local infected tissue as well as an appropriate antimicrobial therapy. We reported here on a case of Bacillus licheniformis bacteremia associated with a bronchoscopic procedure in an immune competent patient.(Tuberc Respir Dis 2004; 57:553-556)
BACKGROUND: To find out effectiveness of multimodality treatments based on induction chemotherapy(CTx) in patients with clinical stage IIIA NSCLC0aMETHODS: From 1997 to 2002, 74 patients with clinical stage IIIA NSCLC underwent induction CTx at the hospital of Chungnam National University. Induction CTx included above two cycles of cisplatin-based regimens(ectoposide, gemcitabine, vinorelbine, or taxol) followed by tumor evaluation. In 30 complete resection group, additional 4500-5000cGy radiotherapy(RTx) was delivered in 15 patients with pathologic nodal metastasis. 29 out of 44 patients who were unresectable disease, refusal of operation, and incomplete resection were followed by 60-70Gy RTx in local treatment. Additional 1-3 cycle CTx were done in case of induction CTx responders in both local treatment groups. 0aRESULTS: Induction CTx response rate were 44.6%(complete remission 1.4% & partial response 43.2%) and there was no difference of response rate by regimens(py 33 out of resectable 55 ones(including initial resectable 37 patients) were performed by surgical treatment because of 13 refusal of surgery by themselves and 9 poor predicted reserve lung function. There were 30(40.5%) patients with complete resection, 2(2.6%) persons with incomplete resection, and 1(1.3%) person with open & closure. Response rate in 27 ones with chest RTx out of non-operation group was 4.8% CR and 11.9% PR. In complete resection group, relapse free interval was 13.6 months and 2 year recur rate was 52%. In non-complete resection(incomplete resection or non-operation) group, disease progression free interval was 11.2 months and 2 year disease progression rate was 66.7%. Median survival time of induction CTx 74 patients with IIIA NSCLC was 25.1months. When compared complete resection group with non-complete resection group, the median survival time was 31.7 and 23.4months(pve RTx subgroup significantly improved the 2-year local control rate(0% vs. 40%, ps, especially followed by complete resection, but overall survival by any local treatment(surgical resection or RTx) was low. Additional studies should be needed to analysis data for appropriate patient selection, new chemotherapy regimens and the time when should RTx be initiated
Background : The effect of PEEP(ed note: Define PEEP.) on the lung volume in patients with auto-PEEP during mechanical ventilation is not even. In patients with an expiratory limitation such as COPD, a PEEP of 85% from an auto-PEEP can be used with minimal increase in the lung volume. However, the application of PEEP to patients without an expiratory flow limitation can result in progressive lung. This study was carried out to evaluate the different PEEP effects on the lung volume according to the different pulmonary diseases. Methods : Sixteen patients who presented with auto-PEEP during mechanical ventilation were enrolled in this study. These patients were divided into 3 groups: asthma, COPD and tuberculosis sequela (patients with severe cicatrical fibrosis as a result of previous tuberculosis and compensatory emphysema). A PEEP of 25, 50, 75 and 100% of the auto-PEEP was applied, and the lung volume increments were estimated using the trapped lung volume. Results : In the asthma group, the trapped lung volume was not increased at a PEEP of 25 and 50% of the auto-PEEP. This group showed a significant lung volume increment from a 75% PEEP. In the COPD group, the lung volume was increased only at 100% PEEP. In the tuberculosis sequela group, the lung volume was increased progressively from low PEEP levels. However, a significant increment of the lung volume was noted only at 100% PEEP. Conclusion : The effects of the applied PEEP on the lung volume were different depending on the underlying lung pathology. The level of the applied PEEP >50% of the auto-PEEP might increase the trapped lung volume in patients with asthma. (Tuberc Respir Dis 2004; 57:567-572)
저자들은 폐색전증과 파종성혈관내응고를 동반한 특발성 과호산구 증후군 1례를 경험하였다. 환자는 스테로이드 투여로 빠른 호전이 없어 시클로스포린을 추가하여 호전되었다.
The idiopathic hypereosinophilic syndrome (HES) comprises a heterogeneous group of disorders with unknown pathogenesis characterized by persistent peripheral blood and bone marrow eosinophilia. And the eosinophil infiltrates of multiple organs in HES lead to severe organ dysfunction. The disseminated intravascular coagulation (DIC) is a rare complication of HES. We have experienced a case of HES complicated with DIC and pulmonary thromboembolism. After intravenous injection of methylprednisone, blood eosinophil count was normalized but DIC was persisted. With cortico steroid and cyclosporine therapy, the disease activity was favorably remitted. (Tuberc Respir Dis 2004; 57:573-578)
저자들은 폐색전증과 파종성혈관내응고를 동반한 특발성 과호산구 증후군 1례를 경험하였다. 환자는 스테로이드 투여로 빠른 호전이 없어 시클로스포린을 추가하여 호전되었다.
Actinomycosis is an indolent infectious disease characterized by pyogenic response and necrosis, followed by intense fibrosis. The main forms of human actinomycosis are cervicofacial, pulmonary, and abdominopelvic type. Pulmonary actinomycosis accounts for 15% to 20% of total cases and unfortunately, clinical manifestations and radiologic findings are nonspecific. Small pleural effusion or empyema may develop in advanced disease but massive empyema is infrequent and rarely reported. We report a case of huge empyema caused by pulmonary actinomycosis in a 55 year-old man, presented with one-month history of productive cough and fever. The CT scan revealed a huge cavity with air-fluid level occupying the left hemithorax. Empyema caused by actinomycosis was confirmed microscopically by demonstration of sulfur granules in empyema sac through thracotomy. Decortication and surgical resection of empyema sac and destructed lung was accomplished and followed by intravenous infusion of penicillin G.(Tuberc Respir Dis 2004; 57:579-583)
수년간의 반복되는 객혈로 내원한 21세 여자환자에서 방사선학적 소견상 진균덩이가 의심되어 흉강경을 이용한 우하엽 절제술을 시행하였으며, 절제한 조직의 병리 조직학적 검사상 기관지 기원 낭내 발생한 국균종과 이에 동반된 방선균증으로 진단된 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
Pulmonary aspergilloma usually arises in preexisting lung cavities characterized by recurrent hemoptysis. Although surgical resection of the aspergilloma is the best treatment, most patients are poor candidates for surgery because of far-advanced underlying pulmonary disease. On the other hand, pulmonary actinomycosis is a chronic, indolent bacterial infection and follows aspiration of oropharyngeal material. Bronchiectasis and obstructive lung disease are often associated underlying conditions. We report a case of pulmonary aspergilloma in bronchogenic cyst associated with an actinomycosis in 21-year-old woman treated by thoracoscopic surgery with a review of literature. (Tuberc Respir Dis 2004; 57:584-588)
Aspergillus fumigatus causes a variety clinical syndrome in lung including aspergilloma, chronic necrotizing aspergillosis, invasive pulmonary aspergillosis, and allergic bronchopulmonary aspergillosis. Aspergilloma develops by a colonization and growing of Aspergillus inside lung cavities with underlying lung disease. There is a few report of endobronchial aspergilloma without lung parenchymal lesion. We experienced a case of endobronchial aspergilloma did not fit any category of Aspergillus-induced lesion, who show minimal fibrostreaky denstities on chest PA and chest CT. Massive hemoptysis was improved by a removal of the aspergilloma in this patient. Here, we report a rare case of endobronchial aspergilloma showing massive hemoptysis with review of literatures. (Tuberc Respir Dis 2004; 57:589-593)
원발성 반지세포 폐암종은 점액을 분비하는 독특한 선암의 일종으로 매우 드물게 발생한다. 예후가 불량하므로 타 원발성 및 전이성 폐암종과 감별이 필요하고 임상적인 검사로 원발병소를 찾기가 어려울 경우 조직면역학적 방법이 감별에 도움이 된다. 본 저자들은 다발전 골전이를 동반한 진행된 원발성 반지세포 폐암종의 증례를 문헌고찰과 함께 보고하는 바이다.
Signet ring cell carcinoma of lung is an unique variant of mucin producing adenocarcinoma which is characterized by abundant intracellular mucin accumulation. Only a few cases of primary signet ring cell carcinoma of lung have been reported in the world wide literature. And we have, recently experienced one case of primary signet ring cell carcinoma of lung. A 55 years old man was evaluated for paralysis of lower extremities and was found to have lung cancer in the left upper and lower lobe with pleural, multiple spinal, bone and liver metastases. Signet ring tumor cells were revealed by cytologic examination of pleural fluids. And there were no evidence of signet ring cell carcinoma of other organs. Primary signet ring cell carcinoma of lung seems to have an aggressive behavior and therapeutic modalities could be different from those for signet ring cell carcinomas from other organs. Therefore it is important to separate primary signet ring cell adenocarcinoma of lung from metastatic tumors. (Tuberc Respir Dis 2004; 57:594-598)
Primary pericardial malignant mesothelioma is a lethal and rare cardiac neoplasm of mesodermal origin. Most cases are associated with history of pericarditis with constriction and/or tamponade. Authors experienced a case of primary pericardial malignant mesothelioma in a 55-year old female who had suffered from dyspnea and chest pain. Pericardial nodules revealed intense uptake by FDG-PET scan and confirmed as primary pericardial malignant mesothelioma by thoracoscopic biopsy. Here we report this case with a brief review of the relevant literatures. (Tuberc Respir Dis 2004; 57:599-603)
외인성 지방성 폐렴은 흔한 질환은 아니지만 동물성, 식물성 및 광물성 지방 물질이 원인이 될 수 있으며 발견된 예보다 훨씬 빈도가 많을 것으로 판단된다. 따라서 자세한 병력 청취로 원인 물질에 대한 노출을 우선 확인하여 지방성 폐렴을 의심하는 것이 선행되어야 한다.
Primary pericardial malignant mesothelioma is a lethal and rare cardiac neoplasm of mesodermal origin. Most cases are associated with history of pericarditis with constriction and/or tamponade. Authors experienced a case of primary pericardial malignant mesothelioma in a 55-year old female who had suffered from dyspnea and chest pain. Pericardial nodules revealed intense uptake by FDG-PET scan and confirmed as primary pericardial malignant mesothelioma by thoracoscopic biopsy. Here we report this case with a brief review of the relevant literatures. (Tuberc Respir Dis 2004; 57:599-603)